A hidden curriculum for environmental topics in medical education: Impact on environmental knowledge and awareness of the students

Objective: Climate change constitutes a major challenge. The higher education sector plays an important role in regard to climate change and the adaptation to its consequences. Various approaches toward the integration of environmental subject areas to higher education teaching have already been described in other studies, but there is a lack of data supporting the effectiveness of these approaches in changing not only the environmental knowledge of students, but also their awareness. To address this, the present study tracked whether student attitudes about the environment could be changed by implicitly addressing medically relevant environmental topics as part of an online seminar. Methods: Second semester students of molecular medicine attending a mandatory 14-hour online seminar, which was required to obtain additive key qualifications and which consisted of independent study phases as well as online class meetings, were divided into two groups: the intervention group (IG, n=27, thereof 20 in the pretest and 21 in the posttest) was exposed to medically relevant environmental topics, while the comparison group (CG, n=26, thereof 22 in the pretest and 21 in the posttest) was exposed to general, non-environmental medical topics. Surveys were conducted with standardized questionnaires before and after the seminar in order to study the influence on the students’ environmental knowledge, awareness and other personal attitudes. Results: While the seminar did not significantly change the environmental awareness in either group, the environmental knowledge of the IG was significantly increased by the group’s exposure to environmental topics. In addition, the IG assessed its own environmental awareness regarding sustainable working methods in a laboratory as significantly higher after the seminar than the CG did, and some students of the IG had become more interested in issues relating to sustainability. Conclusion: The approach used to communicate environmental content mainly increased the environmental knowledge of students and piqued the interest of some students in climate-related and environmental topics. However, it was not possible to change deeper personal attitudes about environmental awareness, especially everyday behavior.

I have already completed training in the medical and/ or scientific field (with/ without working in the profession and total duration > 1 year). [1] yes no Prior to this study, I have attended other university studies in the medical and/ or scientific field (at least one year). [1] yes no I am regularly committed (voluntarily) in the field of environmental issues (BUND, university group for sustainability of the University of Ulm, etc.). [1] yes no

Environmental affect
Please rate the following statements (agreement on Likert-type scale from 1-6 = strongly disagree -strongly agree) 1. I am worried about the environmental conditions in which future generations will probably have to live. [2] 2. It angers me when I see that Germany is failing to meet its climate protection targets. [2] 3. I get annoyed when others try to tell me that I should live in an environmentally conscious manner. [2] 4. Climate change threatens our quality of life here in Germany as well. [2] 5. Many environmental protection associations greatly exaggerate environmental problems.
[2] 6. I feel powerless, because I think that average consumers can hardly contribute as much to energy conservation compared to industries. [

Environmental cognition
Please rate the following statements (agreement on Likert-type scale from 1-6 = strongly disagree -strongly agree) 1. Regular people can make a significant contribution to environmental protection with our consumption and mobility behavior. [4] 2. Things other than the environment or nature are more important for leading a good life.
[2] 3. We should all be willing to lower our current standard of living for the sake of the environment.
[2] 4. Our way of life makes us responsible for many environmental problems in other countries as well (e.g. through the exploitation of raw materials or waste export). [3] 5. Science and technology will solve many environmental problems without requiring us having to change our way of life. [3] 6. We need more economic growth in the future, even if it burdens the environment. [2] 7. We should not consume more raw materials than can be regrown. [2] 8. Each and every individual bears responsibility for leaving a livable environment for future generations. [2]

Environmental behavior
Please rate the following statements (agreement on Likert-type scale from 1-6 = strongly disagree -strongly agree) 1. When buying food, I pay attention to the sustainability of the products (environmental compatibility, fair working conditions) and prefer to choose those with environmental and organic labels.
[3] 2. At main meals, I almost always eat meat or sausage. [2] 3. I mainly buy second-hand products (online, flea markets, etc.). [1] 4. For my everyday errands I ride a bicycle, use public transportation or walk. [2] 5. I can imagine myself getting involved in environmental protection and nature conservation.
[3] 6. I turn off electronic devices completely when not in use (not in stand-by mode). [4] 7. I often fly for private travel. [1] 8. When it comes to vacation, a destination far from home (long-distance travel) is important to me. [1] 5 Seminar-and student-specific questions